A case report of postsplenectomy reactive thrombocytosis leading to an acute myocardial infarction in a previously healthy adult without hematologic comorbidities.

RATIONALE

Reactive thrombocytosis frequently occurs after splenectomy. While splenectomy-induced reactive thrombocytosis (SI-RT) might be linked to thromboembolic risks, the causative relationship remains unclear.

PATIENT CONCERNS

A 72-year-old male with hypertension underwent elective splenectomy for a large splenic hematoma. Postoperative recovery was uneventful until day 11, when he developed sudden epigastric pain and vomiting.

DIAGNOSES

Laboratory findings revealed significant thrombocytosis (platelet count: 972 K/μL) and elevated troponin levels, with an electrocardiogram confirming an acute ST-segment elevation myocardial infarction. Coronary angiography identified triple-vessel disease with total occlusion of the proximal left anterior descending artery.

INTERVENTIONS

The patient was successfully treated with a drug-eluting stent.

OUTCOMES

The patient was discharged in stable condition after receiving appropriate post-procedural management and showed no further complications at 5 months.

LESSONS

SI-RT can cause severe thromboembolic complications despite the lack of conclusive evidence linking it to such events, and prophylactic anticoagulants are not routinely recommended. These considerations highlight the need for vigilant inpatient monitoring and thorough patient education at discharge to promptly address potential complications, as well as the importance of establishing guidelines for antiplatelet therapy in SI-RT patients without contraindications to minimize risks.